Data from a recently published study(www.jabfm.org) conducted by the AAFP National Research Network (AAFP NRN) suggest that the American Board of Family Medicine Maintenance of Certification for Family Physicians (ABFM MC-FP) program -- specifically, the self-assessment (Part II) and performance-in-practice (Part IV) modules -- have a positive influence on quality of care.

According to Wilson Pace, M.D., director of the AAFP NRN and professor at the University of Colorado School of Medicine in Aurora, physicians who completed MC-FP Part II or Part IV modules showed significantly greater improvements in patient care than those who did not.

The study sprang from the ABFM's desire to demonstrate whether its MC-FP requirements had an impact on clinical care, Pace told AAFP News. Using the AAFP NRN's Electronic National Quality Improvement and Research Network (eNQUIRENet), researchers were able to link the electronic health records (EHRs) of individual physicians' patients to the dates those physicians completed MC-FP Part II and/or Part IV modules, allowing the researchers to gauge the potential impact of those modules on patient care. The results were published in the January-February issue of the Journal of the American Board of Family Medicine.

Overall, the ABFM-funded study sought to examine the relationship between a physician's completion -- or noncompletion -- of an MC-FP learning module and the type of care that physician's patients received, along with their health outcomes. For example, researchers noted whether patients received annual foot exams, regular blood pressure checks and other recommended tests (e.g., cholesterol, hemoglobin A1c). Patient outcomes also were measured based on the results of lab tests and exams. For physicians who did complete such a module, patient care data from the year before the physician's last completed module were compared with patient care data from the year after completion.

Seventy-six physicians from 15 eNQUIRENet practices participated in the study. The physicians were treating a total of 4,677 patients with type 2 diabetes. Participating physicians were categorized into one of three groups: those who had completed either a Part II or Part IV module in diabetes between Jan. 1, 2007, and Dec. 31, 2009; those who had completed a Part II or Part IV module in any topic during that time period; and those who had not completed either type of module.

"Overall, physicians were improving, but we saw even more improvement in the group that participated in the diabetes maintenance of certification programs," said Brian Manning, M.P.H., associate research director of the AAFP NRN and corresponding author of the study report.

In addition to those who completed diabetes-specific MC-FP modules, physicians who had completed any Part II or Part IV module also showed greater improvements in most aspects of patient care researchers analyzed than did their counterparts who had not completed any of the modules.

Specifically, physicians who completed diabetes modules showed significant improvement in ACE inhibitor/angiotensin receptor blocker use, blood pressure checks and hypertension control than those who had not completed any modules. Improvement in intermediate clinical outcomes was greater for this group, as well.

"Both groups who did maintenance of certification improved, and they improved more than those who didn't," said Pace. "Overall, maintenance of certification did make a difference, and, in fact, we saw overlap that extended across patient populations."

Not surprising, Pace added, given that during the timeframe of the study, the range of topics MC-FP modules addressed were fairly limited. "If physicians hadn't done (the) diabetes (module), they most likely did (a module on) hypertension or cardiovascular disease," he said. Care recommendations for patients with these conditions are similar, he noted.

Although the study was unable to draw conclusions about specific MC-FP activities, the data should be encouraging to physicians who have doubted the impact of the new Part IV module, saying it's too costly and time-consuming, Pace said.

"Because physicians were struggling with Part IV and had doubts about whether it worked, the (specialty certifying) boards have had pushback on Part IV," Pace said. The findings of this study should be reassuring to those with these concerns, he added.

Studying the impact of maintenance of certification on patient health outcomes is "new territory," according to Manning. In addition to showing a positive relationship between patient care and maintenance of certification, researchers also proved they could match the ABFM records of program completion with eligible patients' EHR data.

"This study is laying the groundwork for the future, for showing evidence at the population level," Manning said.